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本法的阳性率比超声检查和IVP高1倍左右。 | [
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由于瘢痕征并不全是真正的组织坏死后纤维化，而仍有较多的缺血和炎症成分，故可以由功能性肾静态显像发现，而难以被形态学检查法发现。 | [
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尿路感染患儿有肾瘢痕，说明感染已定位于肾实质，可作为小儿肾盂肾炎的诊断参考指标，对预后、正确治疗和疗效观察有重要意义。 | [
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由于瘢痕的上述性质，经过积极治疗可见缩小甚至消退。 | [
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肾动态显像的肾实质影像和排出影像也可见到瘢痕肾多样异常表现，但因影像质量不如肾静态显像，故为诊断肾瘢痕应首选肾静态显像，动态显像仅有参考价值。 | [
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（三）膀胱输尿管尿反流（vesicoureteralreflux，VUR）显像膀胱尿反流显像分直接和间接两种方法。 | [
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直接法是将99m</sup>TcO4</sub>-</sup>148MBq（4mCi）经导尿管注入膀胱内，然后用生理盐水缓缓灌注，待膀胱充盈完全后用力排尿，在此过程中，用γ相机以1～2秒一帧的速度连续照相，无论在充盈期或γ相机，输尿管或肾内有放射性出现，即可诊断为膀胱尿反流。 | [
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间接法则是在进行肾肾动态显像很少时，令受检者尽量憋住尿，然后用力排尿，在此过程中用γ相机快速照相，也可观察有无膀胱输尿管反流的存在和程度。 | [
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核素法和X线法对膀胱尿反流的诊断率大致相同，且二者有约80%的X线法性，对重度反流为100%。 | [
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针对X线法的使受检患儿性腺的辐射吸收剂量较大的突出的缺点，核素法所致小儿性腺的辐射吸收剂量明显要低，仅为上述剂量的1/100左右。 | [
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第十三节尿道下裂尿道下裂是一种尿道发育畸形，即尿道开口在阴茎腹侧正常尿道口近端至会阴部的途径上小儿泌尿生殖系统最常见的畸形之一。 | [
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近来，由于环境污染、农作物大量使用化肥和促生长剂，尿道下裂在欧美报道有上升之势。 | [
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尽管在尿道下裂的手术治疗上已经有了非常大的进步，但无论从医生的角度还是患儿或其父母的角度，尿道下裂的治疗结果远不如人意。 | [
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【胚胎学】胚胎第6周时，尿生殖窦的腹侧出现一个突起，称为生殖结节。 | [
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在生殖结节的尾侧正中线上有一条浅沟，称为尿道沟。 | [
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尿道沟两侧隆起部分为尿生殖褶。 | [
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男性在双氢睾酮的作用下，生殖结节增长形成阴茎，尿生殖窦的下段伸入阴茎并开口于尿道沟，以后尿道沟两侧的尿生殖褶由近端向远端相互融合，形成尿道，此时尿道外口移到阴茎头冠状沟部。 | [
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在阴茎头顶部，外胚层向内生长出一个细胞索，以后细胞索中央与尿道沟相通，使尿道外口移到阴茎头顶端。 | [
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第12周时，阴茎头处形成皮肤反折，称为包皮。 | [
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生殖结节内的间质分化为阴茎海绵体及尿道海绵体。 | [
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在胚胎期由于内分泌的异常或其他原因导致尿道沟融合不全时，即形成尿道下裂。 | [
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由于尿道远端的形成处于最后阶段，所以尿道口位于阴茎体远端的尿道下裂占比例最大。 | [
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【病因】1.基因遗传尿道下裂发病有一定的家族倾向，但所涉及的基因或染色体的具体情况尚不清楚。 | [
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我们碰到数例父子或兄弟，特别是孪生兄弟同患此病的，有报道10%患儿的父亲及15%患儿的兄弟中有尿道下裂。 | [
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2.激素影响从胎睾中产生的激素影响男性外生殖器的形成。 | [
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由绒毛膜促性腺激素刺激睾丸间质细胞（leydigcells）在孕期第8周开始产生睾酮，再转化形成双氢睾酮。 | [
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外生殖器的发育受双氢睾酮的调节。 | [
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睾酮产生不足、过迟，或者睾酮转化成双氢睾酮的过程出现异常均可导致生殖器畸形。 | [
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尿道下裂常伴发于隐睾、两性畸形就与此相关。 | [
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母亲孕前、孕期的激素应用对胎儿生殖系统的发育也有一定的影响。 | [
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【临床表现】尿道下裂的临床表现非常有特点，①尿道开口异位尿道异位开口于从正常尿道口近端至会阴部的任何部位部分尿道口有轻度狭窄因其表面有一层非常薄的黏膜样组织不完全覆盖所致有时尿道的一段海绵体缺如，其壁菲薄尿线一般向后，故患儿常取蹲位排尿，尿道口位于阴茎体近端时更明显阴茎向腹侧弯曲，主要因尿道口远端的尿道板纤维组织增生阴茎腹侧和尿道壁各层组织缺乏以及阴茎海绵体背、腹两侧不对称所致包皮堆积于背侧，阴茎头腹侧包皮未能在中线融合包皮系带缺如，全部包皮转至阴茎背侧，呈帽状堆积尿道口位置尿道下裂分为四型，阴茎头型、阴茎体型、阴茎阴囊型和会阴型（图12-8）。 | [
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{
"end_idx": 107,
"entity": "尿线一般向后",
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有些病例其阴茎弯曲非常严重，尿道开口仍可位于阴茎远端患儿甚至还可站立解尿，但一旦术中将纤维索带组织松解，尿道口即会退至阴茎近端尿道下裂的分型【伴发畸形】尿道下裂最常见的伴发畸形为腹股沟斜疝及睾丸下降不全，各占10%左右。 | [
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尿道下裂越严重，伴发畸形的发生率也越高重，伴发畸形的发生率也越高。 | [
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尿道下裂患儿伴发上尿路畸形的发生率1%～3%不等，如肾盂输尿管连接部梗阻及重复畸形等。 | [
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也有少数病人合并肛门直肠畸形。 | [
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【诊断及鉴别诊断】尿道下裂的诊断由于其外观的特征性改变，并不困难，一望可知。 | [
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关键是应明确尿道下裂可能是某些严重泌尿生殖系畸形如两性畸形的表现。 | [
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尤其是比较严重的尿道下裂，畸形伴发率高，要注意鉴别有无性别异常。 | [
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对外生殖器表现模棱两可的、尿道下裂伴隐睾的都要首先进行染色体检查；如明确为男性的46XY，则先行睾丸下降固定，同时进行性腺活检。 | [
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如为睾丸，但发育很差，加之阴茎发育很小的情况，要和家属商讨，考虑做成女性为好。 | [
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【手术治疗】手术行尿道成形是尿道下裂唯一的治疗方法。 | [
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手术要求达到完全矫正阴茎下弯、尿道正位开完全矫正阴茎下弯、尿道正位开口于阴茎头、能站立排尿以及成年后能进行正常性生活的目的术方法有200多种，但至今尚无一种满意的被所有医师接受的术式。 | [
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相对来说比较常用的手术方法有尿道口前移龟头成形术（meata尿道口前移龟头成形术ndgmeataladvancementandglanuloplastyincorporatedprocedure或FMAGPIFlapMathieu，Filp-Flap尿道成形术la加盖岛状皮瓣尿道成形术成形onlayislandflap尿道成形术皮内板横行岛状皮瓣尿道成形术包皮内板横行岛状皮瓣尿道成形术十年Duckett术多的在无阴茎下弯的尿道下裂中应用尿道板纵切卷管尿道成形术（也尿道板纵切卷管尿道成形术。 | [
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波士顿儿Snodgrass术尿道下裂尿道成形术的50%是采用此方尿道成形术特点是手术简单，尿道外口美观，并发症低。 | [
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手术的主要并发症包括：尿瘘、尿道狭窄、尿道憩室形成尿瘘、尿道狭窄、尿道憩室形成、阴茎弯曲及阴茎扭转总体发生率约有30%左右其总体发生率约有30%左右尚难有效解决。 | [
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"end_idx": 26,
"entity": "尿瘘",
"start_idx": 25,
"type": "dis"
},
{
"end_idx": 31,
"entity": "尿道狭窄",
"start_idx": 28,
"type": "dis"
},
{
"end_idx": 38,
"entity": "道憩室形成",
"start_idx": 34,
"type": "dis"
},
{
"end_idx": 43,
"entity": "阴茎弯曲",
"start_idx": 40,
"type": "sym"
},
{
"end_idx": 41,
"entity": "阴茎",
"start_idx": 40,
"type": "bod"
},
{
"end_idx": 48,
"entity": "阴茎扭转",
"start_idx": 45,
"type": "sym"
},
{
"end_idx": 46,
"entity": "阴茎",
"start_idx": 45,
"type": "bod"
}
] |
由于尿道下裂患儿多不能如正常地站立解尿，容易造成其心理负担，影响心理发育，现多主张早期手术。 | [
{
"end_idx": 5,
"entity": "尿道下裂",
"start_idx": 2,
"type": "dis"
},
{
"end_idx": 18,
"entity": "不能如正常地站立解尿",
"start_idx": 9,
"type": "sym"
},
{
"end_idx": 18,
"entity": "尿",
"start_idx": 18,
"type": "bod"
},
{
"end_idx": 35,
"entity": "影响心理发育",
"start_idx": 30,
"type": "sym"
},
{
"end_idx": 44,
"entity": "手术",
"start_idx": 43,
"type": "pro"
}
] |
第七篇感染性疾病第一章感染性疾病的诊断要则感染性疾病是指由病原微生物感染机体引起的一类疾病，这些病原微生物包括细菌、病毒、支原体、衣原体、立克次体、真菌、螺旋体、原虫和蠕虫等。 | [
{
"end_idx": 7,
"entity": "感染性疾病",
"start_idx": 3,
"type": "dis"
},
{
"end_idx": 15,
"entity": "感染性疾病",
"start_idx": 11,
"type": "dis"
},
{
"end_idx": 25,
"entity": "感染性疾病",
"start_idx": 21,
"type": "dis"
},
{
"end_idx": 35,
"entity": "病原微生物感染",
"start_idx": 29,
"type": "dis"
},
{
"end_idx": 52,
"entity": "病原微生物",
"start_idx": 48,
"type": "mic"
},
{
"end_idx": 56,
"entity": "细菌",
"start_idx": 55,
"type": "mic"
},
{
"end_idx": 59,
"entity": "病毒",
"start_idx": 58,
"type": "mic"
},
{
"end_idx": 63,
"entity": "支原体",
"start_idx": 61,
"type": "mic"
},
{
"end_idx": 67,
"entity": "衣原体",
"start_idx": 65,
"type": "mic"
},
{
"end_idx": 72,
"entity": "立克次体",
"start_idx": 69,
"type": "mic"
},
{
"end_idx": 75,
"entity": "真菌",
"start_idx": 74,
"type": "mic"
},
{
"end_idx": 79,
"entity": "螺旋体",
"start_idx": 77,
"type": "mic"
},
{
"end_idx": 82,
"entity": "原虫",
"start_idx": 81,
"type": "mic"
},
{
"end_idx": 85,
"entity": "蠕虫",
"start_idx": 84,
"type": "mic"
}
] |
其范畴远远超过以往定义的“传染病”，如外科的感染疾病、术后感染，耳鼻喉科的中耳炎和鼻窦炎，以及内科的呼吸道感染、肠道感染疾病等都属感染性疾病。 | [
{
"end_idx": 20,
"entity": "外科",
"start_idx": 19,
"type": "dep"
},
{
"end_idx": 25,
"entity": "感染疾病",
"start_idx": 22,
"type": "dis"
},
{
"end_idx": 30,
"entity": "术后感染",
"start_idx": 27,
"type": "dis"
},
{
"end_idx": 35,
"entity": "耳鼻喉科",
"start_idx": 32,
"type": "dep"
},
{
"end_idx": 39,
"entity": "中耳炎",
"start_idx": 37,
"type": "dis"
},
{
"end_idx": 43,
"entity": "鼻窦炎",
"start_idx": 41,
"type": "dis"
},
{
"end_idx": 48,
"entity": "内科",
"start_idx": 47,
"type": "dep"
},
{
"end_idx": 54,
"entity": "呼吸道感染",
"start_idx": 50,
"type": "dis"
},
{
"end_idx": 61,
"entity": "肠道感染疾病",
"start_idx": 56,
"type": "dis"
},
{
"end_idx": 69,
"entity": "感染性疾病",
"start_idx": 65,
"type": "dis"
}
] |
医院内感染是相对于社区感染而言的概念，也属感染性疾病范畴。 | [
{
"end_idx": 4,
"entity": "感染",
"start_idx": 3,
"type": "dis"
},
{
"end_idx": 12,
"entity": "感染",
"start_idx": 11,
"type": "dis"
},
{
"end_idx": 25,
"entity": "感染性疾病",
"start_idx": 21,
"type": "dis"
}
] |
感染性疾病有其特异的病原微生物，因此病原学诊断尤为重要，是确诊的主要依据。 | [
{
"end_idx": 4,
"entity": "感染性疾病",
"start_idx": 0,
"type": "dis"
},
{
"end_idx": 14,
"entity": "病原微生物",
"start_idx": 10,
"type": "mic"
}
] |
感染性疾病的诊断过程中，要充分注意以下环节。 | [
{
"end_idx": 4,
"entity": "感染性疾病",
"start_idx": 0,
"type": "dis"
}
] |
如伤寒杆菌只可能在早期伤寒患者的血中发现，1周以后才能从患者粪便中查到此菌。 | [
{
"end_idx": 4,
"entity": "伤寒杆菌",
"start_idx": 1,
"type": "mic"
},
{
"end_idx": 12,
"entity": "伤寒",
"start_idx": 11,
"type": "dis"
},
{
"end_idx": 16,
"entity": "血",
"start_idx": 16,
"type": "bod"
},
{
"end_idx": 31,
"entity": "粪便",
"start_idx": 30,
"type": "bod"
},
{
"end_idx": 36,
"entity": "菌",
"start_idx": 36,
"type": "mic"
}
] |
2.标本采集的最有价值部位是感染所在部位，如肺炎的标本应该是真正从下呼吸道取得的痰。 | [
{
"end_idx": 15,
"entity": "感染",
"start_idx": 14,
"type": "dis"
},
{
"end_idx": 23,
"entity": "肺炎",
"start_idx": 22,
"type": "dis"
},
{
"end_idx": 36,
"entity": "下呼吸道",
"start_idx": 33,
"type": "bod"
},
{
"end_idx": 40,
"entity": "痰",
"start_idx": 40,
"type": "bod"
}
] |
三、周围肺动脉狭窄自肺动脉瓣以后的肺动脉管道狭窄可发生于从主干至肺内动脉的各段，单发或多发，大多伴有其他畸形如肺动脉瓣狭窄，室间隔缺损、法洛四联症及主动脉瓣上狭窄（supravalvularaorticstenosis）等。 | [
{
"end_idx": 8,
"entity": "周围肺动脉狭窄",
"start_idx": 2,
"type": "dis"
},
{
"end_idx": 13,
"entity": "肺动脉瓣",
"start_idx": 10,
"type": "bod"
},
{
"end_idx": 23,
"entity": "肺动脉管道狭窄",
"start_idx": 17,
"type": "dis"
},
{
"end_idx": 30,
"entity": "主干",
"start_idx": 29,
"type": "bod"
},
{
"end_idx": 35,
"entity": "肺内动脉",
"start_idx": 32,
"type": "bod"
},
{
"end_idx": 53,
"entity": "畸形",
"start_idx": 52,
"type": "dis"
},
{
"end_idx": 60,
"entity": "肺动脉瓣狭窄",
"start_idx": 55,
"type": "dis"
},
{
"end_idx": 66,
"entity": "室间隔缺损",
"start_idx": 62,
"type": "dis"
},
{
"end_idx": 72,
"entity": "法洛四联症",
"start_idx": 68,
"type": "dis"
},
{
"end_idx": 80,
"entity": "主动脉瓣上狭窄",
"start_idx": 74,
"type": "dis"
},
{
"end_idx": 108,
"entity": "supravalvularaorticstenosis",
"start_idx": 82,
"type": "dis"
}
] |
肺动脉的管腔狭窄依其部位可分为四型：①主干或其左右支；②主干分叉部，并延伸至左右支；③周围分支多发的梗阻；④主干及其周围分支狭窄。 | [
{
"end_idx": 7,
"entity": "肺动脉的管腔狭窄",
"start_idx": 0,
"type": "dis"
},
{
"end_idx": 25,
"entity": "主干或其左右支",
"start_idx": 19,
"type": "bod"
},
{
"end_idx": 40,
"entity": "主干分叉部，并延伸至左右支",
"start_idx": 28,
"type": "bod"
},
{
"end_idx": 51,
"entity": "周围分支多发的梗阻",
"start_idx": 43,
"type": "dis"
},
{
"end_idx": 63,
"entity": "主干及其周围分支狭窄",
"start_idx": 54,
"type": "dis"
}
] |
狭窄部可能产生连续性杂音，尤其伴有左向右分流使肺动脉血流增多者。 | [
{
"end_idx": 11,
"entity": "狭窄部可能产生连续性杂音",
"start_idx": 0,
"type": "sym"
},
{
"end_idx": 21,
"entity": "左向右分流",
"start_idx": 17,
"type": "sym"
},
{
"end_idx": 29,
"entity": "肺动脉血流增多",
"start_idx": 23,
"type": "sym"
},
{
"end_idx": 27,
"entity": "肺动脉血流",
"start_idx": 23,
"type": "ite"
}
] |
心导管可能发现在肺动脉的管道某部前后有明显压差，肺动脉造影可以看到狭窄的部位；为了避免狭窄部被重叠影像掩盖，必须用轴向位置方能将全貌暴露出来。 | [
{
"end_idx": 2,
"entity": "心导管",
"start_idx": 0,
"type": "equ"
},
{
"end_idx": 10,
"entity": "肺动脉",
"start_idx": 8,
"type": "bod"
},
{
"end_idx": 28,
"entity": "肺动脉造影",
"start_idx": 24,
"type": "pro"
}
] |
随着患儿的成长，狭窄可越趋严重，到青春期心排量大增时尤著；再者许多手术如法洛四联症，心内畸形纠正后右心室出路仍受本病的阻挡，应考虑解除的措施。 | [
{
"end_idx": 14,
"entity": "狭窄可越趋严重",
"start_idx": 8,
"type": "sym"
},
{
"end_idx": 27,
"entity": "心排量大增时尤著",
"start_idx": 20,
"type": "sym"
},
{
"end_idx": 22,
"entity": "心排量",
"start_idx": 20,
"type": "ite"
},
{
"end_idx": 40,
"entity": "法洛四联症",
"start_idx": 36,
"type": "dis"
},
{
"end_idx": 45,
"entity": "心内畸形",
"start_idx": 42,
"type": "dis"
},
{
"end_idx": 51,
"entity": "右心室",
"start_idx": 49,
"type": "bod"
}
] |
四、超声检查应用实时B型超声波或三维实时超声。 | [
{
"end_idx": 5,
"entity": "超声检查",
"start_idx": 2,
"type": "pro"
},
{
"end_idx": 14,
"entity": "B型超声波",
"start_idx": 10,
"type": "pro"
},
{
"end_idx": 21,
"entity": "三维实时超声",
"start_idx": 16,
"type": "pro"
}
] |
进食一定量液体时，能够有效地观察到胃窦、胃体、幽门以及十二指肠的动态运动情况，并可将胃排空情况量化。 | [
{
"end_idx": 18,
"entity": "胃窦",
"start_idx": 17,
"type": "bod"
},
{
"end_idx": 21,
"entity": "胃体",
"start_idx": 20,
"type": "bod"
},
{
"end_idx": 24,
"entity": "幽门",
"start_idx": 23,
"type": "bod"
},
{
"end_idx": 30,
"entity": "十二指肠",
"start_idx": 27,
"type": "bod"
},
{
"end_idx": 42,
"entity": "胃",
"start_idx": 42,
"type": "bod"
}
] |
常用功能指标有：①收缩频率；②收缩幅度；③运动指数；④幽门开放时间；⑤胃十二指肠运动协调性；⑥十二指肠、胃反流征观察。 | [
{
"end_idx": 12,
"entity": "收缩频率",
"start_idx": 9,
"type": "ite"
},
{
"end_idx": 18,
"entity": "收缩幅度",
"start_idx": 15,
"type": "ite"
},
{
"end_idx": 24,
"entity": "运动指数",
"start_idx": 21,
"type": "ite"
},
{
"end_idx": 32,
"entity": "幽门开放时间",
"start_idx": 27,
"type": "ite"
},
{
"end_idx": 44,
"entity": "胃十二指肠运动协调性",
"start_idx": 35,
"type": "ite"
},
{
"end_idx": 57,
"entity": "十二指肠、胃反流征观察",
"start_idx": 47,
"type": "ite"
}
] |
对胃的排空功能检查，能准确测量胃的半排空和完全排空时间。 | [
{
"end_idx": 8,
"entity": "胃的排空功能检查",
"start_idx": 1,
"type": "pro"
},
{
"end_idx": 26,
"entity": "胃的半排空和完全排空时间",
"start_idx": 15,
"type": "ite"
}
] |
具体方法：给被检查者一定量的37℃的液体，然后每10分钟测量胃体、胃底及胃窦部前后径、上下径大小和面积，计算出胃窦、胃体面积减少的速度，从而得出胃排空和半排空时间。 | [
{
"end_idx": 50,
"entity": "胃体、胃底及胃窦部前后径、上下径大小和面积",
"start_idx": 30,
"type": "ite"
},
{
"end_idx": 66,
"entity": "胃窦、胃体面积减少的速度",
"start_idx": 55,
"type": "ite"
},
{
"end_idx": 80,
"entity": "胃排空和半排空时间",
"start_idx": 72,
"type": "ite"
}
] |
国内已采用B超对小儿厌食、胃炎及功能性消化不良分别检测。 | [
{
"end_idx": 6,
"entity": "B超",
"start_idx": 5,
"type": "pro"
},
{
"end_idx": 11,
"entity": "小儿厌食",
"start_idx": 8,
"type": "dis"
},
{
"end_idx": 14,
"entity": "胃炎",
"start_idx": 13,
"type": "dis"
},
{
"end_idx": 22,
"entity": "功能性消化不良",
"start_idx": 16,
"type": "dis"
}
] |
本方法准确可靠，重复性好，但技术要求高，适于观察液体排空，但不能确切显示固体胃排空。 | [
{
"end_idx": 38,
"entity": "胃",
"start_idx": 38,
"type": "bod"
}
] |
四、手术技术的特殊性1.儿童肾移植常发生移植物大小和髂窝的空隙不成比例，需将移植肾置入腹膜后、盲肠后以及腹腔内。 | [
{
"end_idx": 3,
"entity": "手术",
"start_idx": 2,
"type": "pro"
},
{
"end_idx": 16,
"entity": "儿童肾移植",
"start_idx": 12,
"type": "pro"
},
{
"end_idx": 34,
"entity": "移植物大小和髂窝的空隙不成比例",
"start_idx": 20,
"type": "sym"
},
{
"end_idx": 27,
"entity": "髂窝",
"start_idx": 26,
"type": "bod"
},
{
"end_idx": 40,
"entity": "肾",
"start_idx": 40,
"type": "bod"
},
{
"end_idx": 45,
"entity": "腹膜后",
"start_idx": 43,
"type": "bod"
},
{
"end_idx": 49,
"entity": "盲肠后",
"start_idx": 47,
"type": "bod"
},
{
"end_idx": 54,
"entity": "腹腔内",
"start_idx": 52,
"type": "bod"
}
] |
体重＞20kg的儿童移植手术方法与成人相同。 | [
{
"end_idx": 13,
"entity": "儿童移植手术",
"start_idx": 8,
"type": "pro"
}
] |
＜20kg的小儿取腹正中切口入腹腔，游离盲肠，将供肾移植于腹膜后，肾动、静脉分别与主动脉、腔静脉（或髂总动、静脉）吻合，成人供肾体积相对较大时，须将肾脏横置于右侧腹腔内，肾血管与腹部大血管吻合。 | [
{
"end_idx": 10,
"entity": "腹正",
"start_idx": 9,
"type": "bod"
},
{
"end_idx": 16,
"entity": "腹腔",
"start_idx": 15,
"type": "bod"
},
{
"end_idx": 21,
"entity": "盲肠",
"start_idx": 20,
"type": "bod"
},
{
"end_idx": 27,
"entity": "肾移植",
"start_idx": 25,
"type": "pro"
},
{
"end_idx": 31,
"entity": "腹膜后",
"start_idx": 29,
"type": "bod"
},
{
"end_idx": 34,
"entity": "肾动",
"start_idx": 33,
"type": "bod"
},
{
"end_idx": 37,
"entity": "静脉",
"start_idx": 36,
"type": "bod"
},
{
"end_idx": 43,
"entity": "主动脉",
"start_idx": 41,
"type": "bod"
},
{
"end_idx": 47,
"entity": "腔静脉",
"start_idx": 45,
"type": "bod"
},
{
"end_idx": 52,
"entity": "髂总动",
"start_idx": 50,
"type": "bod"
},
{
"end_idx": 55,
"entity": "静脉",
"start_idx": 54,
"type": "bod"
},
{
"end_idx": 63,
"entity": "肾",
"start_idx": 63,
"type": "bod"
},
{
"end_idx": 75,
"entity": "肾脏",
"start_idx": 74,
"type": "bod"
},
{
"end_idx": 83,
"entity": "右侧腹腔内",
"start_idx": 79,
"type": "bod"
},
{
"end_idx": 87,
"entity": "肾血管",
"start_idx": 85,
"type": "bod"
},
{
"end_idx": 93,
"entity": "腹部大血管",
"start_idx": 89,
"type": "bod"
}
] |
2.儿童肾移植（＜5岁）吻合技术需顾及儿童器官的生长过程，至少有半圈采用间断缝合，对边连续缝合进行吻合。 | [
{
"end_idx": 6,
"entity": "儿童肾移植",
"start_idx": 2,
"type": "pro"
},
{
"end_idx": 22,
"entity": "器官",
"start_idx": 21,
"type": "bod"
},
{
"end_idx": 39,
"entity": "间断缝合",
"start_idx": 36,
"type": "pro"
},
{
"end_idx": 46,
"entity": "连续缝合",
"start_idx": 43,
"type": "pro"
}
] |
3.在开放移植肾血流时需考虑婴幼儿心搏出量及收缩压，当不能满足成人供肾血流动力学要求，应尽快输血100～200ml，保持患儿的足够血容量；当阻断主动脉进行血管吻合时，可继发酸中毒，宜给予5%NaHCO3</sub>1～2ml/kg。 | [
{
"end_idx": 9,
"entity": "开放移植肾血流",
"start_idx": 3,
"type": "pro"
},
{
"end_idx": 20,
"entity": "心搏出量",
"start_idx": 17,
"type": "ite"
},
{
"end_idx": 24,
"entity": "收缩压",
"start_idx": 22,
"type": "ite"
},
{
"end_idx": 34,
"entity": "肾",
"start_idx": 34,
"type": "bod"
},
{
"end_idx": 35,
"entity": "血",
"start_idx": 35,
"type": "bod"
},
{
"end_idx": 56,
"entity": "输血100～200ml",
"start_idx": 46,
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},
{
"end_idx": 67,
"entity": "血容量",
"start_idx": 65,
"type": "ite"
},
{
"end_idx": 74,
"entity": "主动脉",
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"type": "bod"
},
{
"end_idx": 78,
"entity": "血管",
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"type": "bod"
},
{
"end_idx": 88,
"entity": "酸中毒",
"start_idx": 86,
"type": "dis"
},
{
"end_idx": 114,
"entity": "给予5%NaHCO3</sub>1～2ml/kg",
"start_idx": 91,
"type": "pro"
}
] |
4.移植前切除双肾的对象经血透不能控制的恶性高血压、慢性肾盂肾炎或多囊肾合并感染不易控制时建议移植前切除双肾。 | [
{
"end_idx": 3,
"entity": "移植",
"start_idx": 2,
"type": "pro"
},
{
"end_idx": 8,
"entity": "切除双肾",
"start_idx": 5,
"type": "pro"
},
{
"end_idx": 14,
"entity": "血透",
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"type": "pro"
},
{
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"entity": "恶性高血压",
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},
{
"end_idx": 31,
"entity": "慢性肾盂肾炎",
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},
{
"end_idx": 39,
"entity": "多囊肾合并感染",
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},
{
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"entity": "移植",
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},
{
"end_idx": 53,
"entity": "切除双肾",
"start_idx": 50,
"type": "pro"
}
] |
对进展迅速的肾小球肾炎，因血循环中存在抗肾小球基底膜抗体，为防止移植后复发，亦应切除病肾，待血循环中抗体消失6个月后再行肾移植手术。 | [
{
"end_idx": 10,
"entity": "肾小球肾炎",
"start_idx": 6,
"type": "dis"
},
{
"end_idx": 13,
"entity": "血",
"start_idx": 13,
"type": "bod"
},
{
"end_idx": 27,
"entity": "抗肾小球基底膜抗体",
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},
{
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{
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"type": "bod"
},
{
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"entity": "血",
"start_idx": 46,
"type": "bod"
},
{
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"entity": "抗体",
"start_idx": 50,
"type": "bod"
},
{
"end_idx": 64,
"entity": "肾移植手术",
"start_idx": 60,
"type": "pro"
}
] |
5.下尿路异常的矫正先天性泌尿道畸形患儿在肾移植前应检查膀胱功能，如膀胱输尿管反流伴肾积水，应施行肾、全输尿管切除术。 | [
{
"end_idx": 6,
"entity": "下尿路异常",
"start_idx": 2,
"type": "dis"
},
{
"end_idx": 17,
"entity": "先天性泌尿道畸形",
"start_idx": 10,
"type": "dis"
},
{
"end_idx": 23,
"entity": "肾移植",
"start_idx": 21,
"type": "pro"
},
{
"end_idx": 29,
"entity": "膀胱",
"start_idx": 28,
"type": "bod"
},
{
"end_idx": 40,
"entity": "膀胱输尿管反流",
"start_idx": 34,
"type": "dis"
},
{
"end_idx": 44,
"entity": "肾积水",
"start_idx": 42,
"type": "dis"
},
{
"end_idx": 57,
"entity": "肾、全输尿管切除术",
"start_idx": 49,
"type": "pro"
}
] |
膀胱有慢性炎症以及神经性膀胱病变，应移植前切除膀胱并在腹膜后形成回盲袋代膀胱。 | [
{
"end_idx": 1,
"entity": "膀胱",
"start_idx": 0,
"type": "bod"
},
{
"end_idx": 6,
"entity": "慢性炎症",
"start_idx": 3,
"type": "dis"
},
{
"end_idx": 15,
"entity": "神经性膀胱病变",
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},
{
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"entity": "移植",
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},
{
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{
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"entity": "腹膜",
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},
{
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"entity": "回盲袋",
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"type": "bod"
},
{
"end_idx": 37,
"entity": "膀胱",
"start_idx": 36,
"type": "bod"
}
] |
二、爽身粉吸入婴幼儿使用爽身粉、痱子粉时误吸所致。 | [
{
"end_idx": 6,
"entity": "爽身粉吸入",
"start_idx": 2,
"type": "dis"
},
{
"end_idx": 14,
"entity": "爽身粉",
"start_idx": 12,
"type": "dru"
},
{
"end_idx": 18,
"entity": "痱子粉",
"start_idx": 16,
"type": "dru"
}
] |
多含有矽酸镁或其他矽酸盐。 | [
{
"end_idx": 5,
"entity": "矽酸镁",
"start_idx": 3,
"type": "dru"
},
{
"end_idx": 11,
"entity": "其他矽酸盐",
"start_idx": 7,
"type": "dru"
}
] |
吸入肺部后造成细支气管阻塞间质性肺炎、肺纤维变性。 | [
{
"end_idx": 3,
"entity": "肺部",
"start_idx": 2,
"type": "bod"
},
{
"end_idx": 12,
"entity": "细支气管阻塞",
"start_idx": 7,
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{
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"entity": "细支气管",
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},
{
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"entity": "间质性肺炎",
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},
{
"end_idx": 23,
"entity": "肺纤维变性",
"start_idx": 19,
"type": "dis"
}
] |
开始为干咳，以后有痰有低热。 | [
{
"end_idx": 4,
"entity": "开始为干咳",
"start_idx": 0,
"type": "sym"
},
{
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"entity": "以后有痰",
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{
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"entity": "痰",
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"type": "bod"
},
{
"end_idx": 12,
"entity": "有低热",
"start_idx": 10,
"type": "sym"
}
] |
有的表现反复呼吸道感染两肺听诊可闻及干湿啰音呛咳、气喘、进行性呼吸困难、发绀等，未经处理可在1～2天内死亡。 | [
{
"end_idx": 10,
"entity": "反复呼吸道感染",
"start_idx": 4,
"type": "dis"
},
{
"end_idx": 21,
"entity": "两肺听诊可闻及干湿啰音",
"start_idx": 11,
"type": "sym"
},
{
"end_idx": 14,
"entity": "两肺听诊",
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{
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"entity": "呛咳",
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},
{
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"entity": "气喘",
"start_idx": 25,
"type": "sym"
},
{
"end_idx": 34,
"entity": "进行性呼吸困难",
"start_idx": 28,
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},
{
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"entity": "发绀",
"start_idx": 36,
"type": "sym"
},
{
"end_idx": 52,
"entity": "未经处理可在1～2天内死亡",
"start_idx": 40,
"type": "sym"
}
] |
胸部X线表现中下肺野有条索状、小片状、斑点状或网状阴影病程长、出现纤维化时，表现两下肺野细小网状影。 | [
{
"end_idx": 3,
"entity": "胸部X线",
"start_idx": 0,
"type": "pro"
},
{
"end_idx": 29,
"entity": "胸部X线表现中下肺野有条索状、小片状、斑点状或网状阴影病程长",
"start_idx": 0,
"type": "sym"
},
{
"end_idx": 9,
"entity": "中下肺野",
"start_idx": 6,
"type": "bod"
},
{
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"entity": "出现纤维化",
"start_idx": 31,
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},
{
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"entity": "两下肺野细小网状影",
"start_idx": 40,
"type": "sym"
},
{
"end_idx": 43,
"entity": "两下肺野",
"start_idx": 40,
"type": "bod"
}
] |
合并感染时可有片絮状阴影。 | [
{
"end_idx": 11,
"entity": "合并感染时可有片絮状阴影",
"start_idx": 0,
"type": "sym"
},
{
"end_idx": 3,
"entity": "合并感染",
"start_idx": 0,
"type": "dis"
}
] |
以对症处理为主，急性大量吸入者可采用支气管镜下冲洗，立即在高湿度下吸氧。 | [
{
"end_idx": 24,
"entity": "支气管镜下冲洗",
"start_idx": 18,
"type": "pro"
},
{
"end_idx": 34,
"entity": "高湿度下吸氧",
"start_idx": 29,
"type": "pro"
}
] |
早期使用肾上腺皮质激素可减轻炎症反应。 | [
{
"end_idx": 10,
"entity": "肾上腺皮质激素",
"start_idx": 4,
"type": "dru"
},
{
"end_idx": 15,
"entity": "炎症",
"start_idx": 14,
"type": "dis"
}
] |
七、异基因造血干细胞移植的植入证据1.异性间移植时可通过性染色体获得证据。 | [
{
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{
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"type": "pro"
},
{
"end_idx": 32,
"entity": "染色体",
"start_idx": 30,
"type": "bod"
}
] |
2.同性别异基因移植者可以通过DNA指纹证据。 | [
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"entity": "同性别异基因移植",
"start_idx": 2,
"type": "pro"
},
{
"end_idx": 17,
"entity": "DNA",
"start_idx": 15,
"type": "bod"
}
] |
二、病理性黄疸新生儿病理性黄疸是新生儿早期除胆红素代谢的特点外，同时有使黄疸加重的疾病或致病因素存在。 | [
{
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"entity": "病理性黄疸",
"start_idx": 2,
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},
{
"end_idx": 14,
"entity": "病理性黄疸",
"start_idx": 10,
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},
{
"end_idx": 24,
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"start_idx": 22,
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},
{
"end_idx": 39,
"entity": "黄疸加重",
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"type": "sym"
},
{
"end_idx": 37,
"entity": "黄疸",
"start_idx": 36,
"type": "dis"
}
] |
但广义的病理性黄疸还包括已过生理性黄疸时期而血清胆红素仍超过正常水平者。 | [
{
"end_idx": 8,
"entity": "病理性黄疸",
"start_idx": 4,
"type": "dis"
},
{
"end_idx": 18,
"entity": "生理性黄疸",
"start_idx": 14,
"type": "dis"
},
{
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"entity": "血清胆红素仍超过正常水平",
"start_idx": 22,
"type": "sym"
},
{
"end_idx": 26,
"entity": "血清胆红素",
"start_idx": 22,
"type": "ite"
}
] |
部分病理性黄疸可致中枢神经系统受损，产生胆红素脑病。 | [
{
"end_idx": 6,
"entity": "病理性黄疸",
"start_idx": 2,
"type": "dis"
},
{
"end_idx": 16,
"entity": "中枢神经系统受损",
"start_idx": 9,
"type": "dis"
},
{
"end_idx": 24,
"entity": "胆红素脑病",
"start_idx": 20,
"type": "dis"
}
] |
我国新生儿高胆的发病率各家报道不一，为9.1%～50.0%，甚至更高。 | [
{
"end_idx": 6,
"entity": "高胆",
"start_idx": 5,
"type": "dis"
}
] |
1997年，徐放生等统计164所医院共收治患病新生儿39621例，其中黄疸患儿13918例，占患病新生儿总数的35.13%；高胆红素血症患儿共收治10365例，占患病新生儿总数的26.16%，黄疸患儿的74.47%；发生胆红素脑病216例，为高胆患儿的2.08%。 | [
{
"end_idx": 36,
"entity": "黄疸",
"start_idx": 35,
"type": "dis"
},
{
"end_idx": 67,
"entity": "高胆红素血症",
"start_idx": 62,
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},
{
"end_idx": 97,
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{
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"start_idx": 110,
"type": "dis"
},
{
"end_idx": 122,
"entity": "高胆",
"start_idx": 121,
"type": "dis"
}
] |
新生儿黄疸有下列情况之一时要考虑病理性黄疸：①生后24小时内出现黄疸，血清胆红素＞102μmol/L（6mg/dl）；②足月儿血清胆红素＞220.6μmol/L（12.9mg/dl），早产儿＞255μmol/L（15mg/dl）；③血清结合胆红素＞34μmol/L（2mg/dl）；④血清胆红素每天上升＞85μmol/L（5mg/dl）；⑤黄疸持续时间较长，超过2～4周，或进行性加重。 | [
{
"end_idx": 4,
"entity": "黄疸",
"start_idx": 3,
"type": "dis"
},
{
"end_idx": 20,
"entity": "病理性黄疸",
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"type": "dis"
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{
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"entity": "生后24小时内出现黄疸",
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{
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"entity": "黄疸",
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{
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"entity": "血清胆红素＞102μmol/L（6mg/dl）",
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"type": "sym"
},
{
"end_idx": 39,
"entity": "血清胆红素",
"start_idx": 35,
"type": "bod"
},
{
"end_idx": 90,
"entity": "足月儿血清胆红素＞220.6μmol/L（12.9mg/dl）",
"start_idx": 60,
"type": "sym"
},
{
"end_idx": 67,
"entity": "血清胆红素",
"start_idx": 63,
"type": "bod"
},
{
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"entity": "早产儿＞255μmol/L（15mg/dl）",
"start_idx": 92,
"type": "sym"
},
{
"end_idx": 139,
"entity": "血清结合胆红素＞34μmol/L（2mg/dl）",
"start_idx": 116,
"type": "sym"
},
{
"end_idx": 122,
"entity": "血清结合胆红素",
"start_idx": 116,
"type": "bod"
},
{
"end_idx": 167,
"entity": "血清胆红素每天上升＞85μmol/L（5mg/dl）",
"start_idx": 142,
"type": "sym"
},
{
"end_idx": 146,
"entity": "血清胆红素",
"start_idx": 142,
"type": "bod"
},
{
"end_idx": 191,
"entity": "黄疸持续时间较长，超过2～4周，或进行性加重",
"start_idx": 170,
"type": "sym"
},
{
"end_idx": 171,
"entity": "黄疸",
"start_idx": 170,
"type": "dis"
}
] |
新生儿病理性黄疸按发病机制可分为红细胞破坏增多（溶血性、肝前性）、肝脏胆红素代谢功能低下（肝细胞性）和胆汁排出障碍（梗阻性、肝后性）三类。 | [
{
"end_idx": 7,
"entity": "病理性黄疸",
"start_idx": 3,
"type": "dis"
},
{
"end_idx": 22,
"entity": "红细胞破坏增多",
"start_idx": 16,
"type": "sym"
},
{
"end_idx": 20,
"entity": "红细胞破坏",
"start_idx": 16,
"type": "dis"
},
{
"end_idx": 25,
"entity": "溶血",
"start_idx": 24,
"type": "sym"
},
{
"end_idx": 25,
"entity": "血",
"start_idx": 25,
"type": "bod"
},
{
"end_idx": 28,
"entity": "肝",
"start_idx": 28,
"type": "bod"
},
{
"end_idx": 43,
"entity": "肝脏胆红素代谢功能低下",
"start_idx": 33,
"type": "sym"
},
{
"end_idx": 37,
"entity": "肝脏胆红素",
"start_idx": 33,
"type": "bod"
},
{
"end_idx": 47,
"entity": "肝细胞",
"start_idx": 45,
"type": "bod"
},
{
"end_idx": 56,
"entity": "胆汁排出障碍",
"start_idx": 51,
"type": "sym"
},
{
"end_idx": 52,
"entity": "胆汁",
"start_idx": 51,
"type": "bod"
},
{
"end_idx": 59,
"entity": "梗阻",
"start_idx": 58,
"type": "dis"
},
{
"end_idx": 62,
"entity": "肝",
"start_idx": 62,
"type": "bod"
}
] |
按实验室测定总胆红素和结合胆红素浓度的增高程度可分为高未结合胆红素血症和高结合胆红素血症，如两者同时存在则称混合性高胆红素血症。 | [
{
"end_idx": 17,
"entity": "总胆红素和结合胆红素浓度",
"start_idx": 6,
"type": "ite"
},
{
"end_idx": 34,
"entity": "高未结合胆红素血症",
"start_idx": 26,
"type": "dis"
},
{
"end_idx": 43,
"entity": "高结合胆红素血症",
"start_idx": 36,
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},
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"entity": "混合性高胆红素血症",
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（一）高未结合胆红素血症引起的原因有：①胆红素产生过多：如母婴血型不合、遗传性球形红细胞增多症、红细胞酶的缺陷（如G-6-PD、丙酮酸激酶、己糖激酶等）、血管外溶血、红细胞增多症等；②肝细胞摄取和结合低下：如肝脏酶系统功能不全引起的黄疸、甲状腺功能低下、进食减少等；③肠-肝循环增加：如胎粪排出延迟等。 | [
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},
{
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},
{
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{
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"entity": "黄疸、甲状腺功能低下",
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},
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},
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},
{
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"entity": "进食减少",
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},
{
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"entity": "肠-肝循环增加",
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},
{
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"entity": "肠-肝",
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},
{
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"entity": "胎粪",
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] |
1.新生儿溶血病因母子血型不合而引起的同族免疫性溶血称为新生儿溶血病（hemolyticdiseaseofnewborn）。 | [
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{
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{
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"entity": "hemolyticdiseaseofnewborn",
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] |
ABO血型不合者较Rh不合多见，大多数母亲为O型，子为A或B型，本病可见于第一胎，可能因其母孕前已受其他原因的刺激，如寄生虫感染，注射伤寒疫苗、破伤风或白喉抗毒素等，均可使机体发生初发免疫反应，当怀孕时再次刺激机体产生免疫抗体，即可通过胎盘进入胎儿引起溶血（详见本章第16节）。 | [
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{
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"entity": "注射伤寒疫苗、破伤风或白喉抗毒素",
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{
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},
{
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"entity": "血",
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2.母乳性黄疸其特征为新生儿以母乳喂养后不久即出现黄疸，可持续数周到数月，而其他方面正常。 | [
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{
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20世纪60年代，文献报道发生率为1%～2%，随着对母乳性黄疸的认识的提高，从20世纪80年代报道的发生率有逐年上升的趋势。 | [
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其发生的原因目前认为主要是因为新生儿胆红素代谢的肠-肝循环增加有关,早发型母乳喂养性黄疸的预防和处理：鼓励尽早喂奶。 | [
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{
"end_idx": 43,
"entity": "早发型母乳喂养性黄疸",
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] |
晚发型母乳性黄疸，血清胆红素＜257μmol/L（15mg/dl）时不需停母乳；＞257μmol/L（15mg/dl）时暂停母乳3天，＞342μmol/L（20mg/dl）时则加光疗，一般不需用清蛋白或血浆治疗。 | [
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},
{
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"entity": "血浆",
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